Asymptomatic Bacteriuria in Kidney Transplant: Approaches to Screening and Treatment—A National Survey of Canadian Nephrologists

BACKGROUND: It is estimated that up to half of kidney-transplant (KT) recipients develop asymptomatic bacteriuria (ASB) within three years posttransplantation. Despite limited evidence supporting screening or treatment, most centers continue routine surveillance and antibiotic therapy, raising concerns about antimicrobial resistance, drug toxicity, and costs. We sought to describe current Canadian practices and perceptions regarding ASB screening and treatment among nephrologists caring for KT recipients. METHODS: Nationwide cross-sectional survey. All nephrologists affiliated with the Canadian Society of Transplantation (CST) Kidney Group were invited to complete a 27-item electronic survey assessing demographic characteristics, ASB screening and treatment practices, and attitudes toward future clinical trials. RESULTS: Thirty-five nephrologists responded (66% response rate, 35/53) from 12 of 18 adult KT centers in Canada (67% national center representation). Forty percent (14/35) were aged 45-54 years; 49% (17/35) were women; and 57% (20/35) had >15 years of transplant experience. Most (28/35, 80%) reported screening for ASB during the first 2 months posttransplant, most often with weekly urine cultures (20/35, 57%; 19/35, 54%), typically until stent removal (21/35, 61%). All respondents (35/35, 100%) treated ASB during this period, most commonly for 7 days (19/35, 54%); 4/35 (11%) ordered additional investigations. After stent removal, only 7/35 (20%) continued screening and 2/35 (6%) continued treatment. Overall, 14/35 (40%) would modify practice if stronger evidence became available, and 31/35 (88%) were willing to participate in a randomized trial withholding antibiotics for ASB. CONCLUSION: Significant variability exists in ASB screening and treatment practices among Canadian nephrologists. These findings highlight a true evidence gap regarding management during the early posttransplant period, rather than a failure to adopt established data, and support the need for pragmatic clinical trials to guide evidence-based ASB management and antimicrobial stewardship.